The Colonoscamy - and What It Reveals About the Need More Now Than Ever for Socialized Medicine

June 16, 2013

Introduction: Four Questions

Should you trust your doctor? Is the medical system organized and controlled
by the modern equivalent of highway robbers? What can we learn from the way
colonoscopies are promoted and priced in America? What is the single most
important takeaway lesson from a brief exploration of these questions?

Here are short answers to the first three of these rhetorical queries. I'm
saving a response to the last question (i.e., recommended course of action)
until the end.

No, don't trust your doctor, if
you are fortunate enough to have ready access to one or more medical
practitioners. Instead, be wary and verify, do independent checks on the
pertinent issues and obtain other qualified opinions. Doctors and other
provider are not your enemies but they're definitely not your friends, either.
They are highly trained professionals who function in a complex dysfunctional
system oriented to profit. Most want to do the right thing but pressures
brought to bear can lead even ethical practitioners to justify action courses
not be in your best interest. In this essay, I'll make the case that your
interests and the public interest take a back seat to a higher power of sorts -
the profit motive.

Yes, the medical system is
highway robbery, circa 21st century.

Plenty can be learned from a
close look at the colonoscopy industrial complex. The procedures being
performed can serve as canaries in the American medical system coal mine. Pay
attention, be alarmed and do what you can to save yourself before it's too
late.

Colonoscopies, Medical Providers and Free
Enterprise Run Amuck

Colonoscopies are the most expensive routine screening test in this
country. A report
by the Commonwealth Fund revealed that this procedure is billed at rates
ranging from $6,385 to $19,438. (See Explaining
High Health Care

Spending in the United States: An
International Comparison of Supply, Utilization, Prices, and Quality, May
3, 2012, Volume 10.) These figures are retail rates for the uninsured; insurers
usually negotiate prices down to about $3,500. Americans fortunate enough to
have employer-based insurance often assume that medical care is basically free,
despite rising co-payments and deductibles, but it's not. Seniors on Medicare
make the same mistake, often because they are exhaustipated (i.e., too tired to give a shit).

Like the high costs of our wars in Iraq and Afghanistan, everyone pays in
the end, no pun intended.

In other Western countries, the price tag for a colonoscopy averages out at
a few hundred dollars. Contrast this with the U.S. experience:

Americans pay more for almost every interaction with the medical system...A
list of drug, scan and procedure prices compiled by the International
Federation of Health Plans, a global network of health insurers, found that the
United States came out the most costly in all 21 categories - and often by a
huge margin." (Source: Elisabeth Rosenthal, “Paying Till It Hurts,” New
York Times, June 1, 2013.)

We lead the world in medical spending, though numerous studies have shown we
do not receive better care and we are less healthy than people in nearly every
other Western nation.

Forms of Highway Robbery in America's
4th Century

In case you have been on the moon or otherwise out of touch for several
years, here's a summary of why so many experts believe the U.S. medical care
system is out of control:

Doctors promote too many tests.
According to the CDC, more than ten million Americans each year undergo
colonoscopies (at a cost of $10 billion annually). One motive for so much
testing is defensive testing. America is
as litigious as it is religious, noted Iris
Vander Pluym, AWR adviser and Matriarch of the Perry Street Palace (in private correspondence). Doctors are required (or
pressured) by insurance regulations or their
employers/partnerships/professional associations to prevent lawsuits, rather
than to patient impoverishment or even bad health outcomes: I ordered a colonoscopy for this patient at
age 50, therefore I cannot possibly be liable for his advanced colon cancer
that turned up two years later.

Pharmaceutical companies saturate the media with direct-to-consumer
merchandizing. The saturation ad campaigns for drugs for whatever does or could
ail you distorts patient judgements. Consumer appetites for quick fixes are
encouraged. Patients are motivated to pressure providers for overpriced,
overrated products.

Greed
rules. So-called non-profit hospitals, insurance companies, device makers and
other players in the medical industry are focused on generating the highest
possible profits they can legally justify. The quest for maximum returns is by
far the number one objective in the American medical system.

High
tech, drug-focused treatments dominate. A disproportionate amount of medical
care and expense is lavished on chronic conditions in later life, leaving fewer
resources for prevention, education and acute care.

Cost/benefits take a back seat. Substantial medical care is lavished on
ministrations that simply extend the dying process.

There
are too few incentives to act sensibly. Overlooked in studies to explain the
high costs and poor return on medical investments relative to other
industrialized countries is a disturbing reality: Americans are overly fond of
guns, gods, demigods and drugs. They are too little committed to reason and
critical thinking, exercise, whole food plant-based dining and the art of
shaping supportive environments for themselves and others.

Colonoscopies As Coal Mine Canaries

The colonoscopy gets my vote as the biggest scam in
modern medicine. We should stop using the term colonoscopy - colonoscamy is much more descriptive and appropriate. Given the abuses and
waste well documented about the U.S. health care system, this is a searing
indictment. Colonoscopies are marketed by fear tactics, not unlike religions.
The high possibilities of horrific torment and premature death from colon
cancer are sometimes described with almost wicked delight by colonoscopy
counselors.

A
year ago, I reluctantly agreed to sit for a pep talk by a renowned
proctologist. The topic was why I should have a colonoscopy, despite no risk
factors save old age. I consented to the interview only after years of get a
colonoscopy badgering by friends, family members and varied medical
practitioners, including even my dentist! The graphic descriptions of dire
consequences of failing to detect a polyp would have done Hieronymus Bosch proud.
I was reminded of the visions drawn by nuns 65 years or so ago at St. Barnabas
Parochial School. The eternal hell-fires were described in such fine and vivid
detail anyone would have been convinced the nuns had been there. I think all
this fright was designed to insure that I never missed a mass on Sundays. (For
a while, I didn't, though I did arrive as late as possible so that my being
there still counted.) So I listened to the colorful colonoscopy pitch - and
still decided not to do it.

Colonoscopies
are billed as quasi operations. What a short time ago was a simple office
procedure has morphed into a more complex booming business. Now there are
surgery centers where lucrative colonoscopies are prescribed and performed in
excess of medical guidelines. The goal is to maximize revenue; lobbying,
marketing and turf battles among specialists, plus huge profit margins, account
for the high costs. Other tests for colon cancer are far less invasive, cheaper
and equally effective, according to a federal

expert
panel on preventive care.

Australia
does not even pay for colonoscopies as a standard screening procedure and it is
not common in other western nations, either. Dr. H. Gilbert Welch, a professor
of medicine at the Dartmouth Institute for Health Policy and Clinical Practice,
is quoted in the Times story cited above, as follows: We've defaulted to by far the most expensive option, without much if
any data to support it.

The American Free Enterprise Anomaly

In this country, the government, unlike in any other industrialized nation,
does not regulate or otherwise intervene in medical pricing, other than setting
payment rates for Medicare and Medicaid. Other nations view health care as a
right for all and regulate hospitals and the rest of the delivery system as
public utilities. What conservatives like to call a free market is not so free
for consumers. Again, citing the Times report: Patients do not see prices until after a service is provided...there is
little quality data on hospitals and doctors to help determine good value...and
even doctors often do not know the costs of the tests and procedures they
prescribe.

Imagine if you went to a restaurant and ordered your meal with no clue what
the dinner would cost. Imagine the anxiety waiting for the waiter to arrive
with the check. Or, apply the medical care model to other normal purchases,
large and small. What if the supermarket groceries you loaded up, took home and
consumed were added up and recorded in your account, but you did not see the
bill for days or weeks, well after you processed most of what you carried off!
Such transactions are ridiculous, of course and yet that's how it is in the
medical system. I sometimes receive bills for medical procedures rendered a
year earlier, after the hospital or medical practitioner has given up on
negotiations for full or good enough payment from the Medicare insurer). It's
bizarre, irrational, unfair and intolerable.

Summary and the Promised Takeaway
Lesson

For starters, read the New York Times story about paying till it hurts
entitled, Colonoscopies Explain Why U.S.
Leads the World in Health Expenditures. It's five times more detailed than
this overview and loaded with references and examples.

Then ask yourself, Do you have to be
passive and tolerate this state of things? Consider that you do not.

First, with regard to colonoscopies, know that for most people, regular
testing for blood in the stool is sufficient. Unfortunately for unwary, easily
intimidated patients, settling for this low cost option is difficult. Such
resistance to colonoscopies will be mightily resisted by medical counselors
involved with the procedure. Stool testing is not a high revenue producer for
this industry. Consider this, also from the Times report: Studies have not clearly shown that a colonoscopy prevents colon cancer
or death better than the other screening methods. Indeed, some recent papers
suggest that it does not, in part because early lesions may be hard to see in
some parts of the colon.

What can you do to avoid spending more for lower quality medical care while
becoming less and less well? You have three options: Die, move or adopt a REAL
wellness lifestyle. Stick with the latter until you do move or die. Personally,
I'm going with the REAL wellness lifestyle. With regard to the colonoscopy
issue, I favor a whole food plant based diet, plenty of exercise and lesser
methods of cancer detection over the unpleasant, costly and dubious invasive
procedure. Life is full of risks - and the flesh is heir to more slings and
arrows than there will ever be costly medical tests to detect and treat early
on.

Getting back to the three options (die, move or adopt a RW lifestyle), I go
with the latter as well because the few countries I'd want to call home
(Australia, New Zealand, Canada and El Dorado) might not have me. But of course
I really and truly favor this choice because REAL wellness is a richer way to
be alive. It's the only way to fly, or live, in my opinion, even if it did not
save money and grief on all kinds of chronic medical problems I'd surely have
to endure if I were obese, sedentary, bored or ornery - and I'm definitely not
fat, sedentary or bored.

My suggested two-part takeaway lessons based on the realities described in
this essay about the colonoscamy scandal in America are:

Adopt a default position on this and all other medical screenings, tests
and procedures - skip them unless different medical experts are able to
convince you that your unique situation and the absence of good alternatives
warrant a screening, test or procedure. In that case, be sure you pursue some
sound estimates of the costs; and

Mitigate your exposure to the medical system by pursuing and always
fine=tuning a first-rate REAL wellness lifestyle.

Lots of luck - given the U.S. medical system, we’re all going to need it.